Improvement of Fatigue and Body Composition in Women with Long COVID After Non-Aerobic Therapeutic Exercise Program, 2025, Miana et al.

[SNT Gatchaman]

Improvement of Fatigue and Body Composition in Women with Long COVID After Non-Aerobic Therapeutic Exercise Program
Miana, María; Moreta-Fuentes, Ricardo; Jiménez-Antona, Carmen; Moreta-Fuentes, César; Laguarta-Val, Sofía

BACKGROUND/OBJECTIVE
Fatigue is one of the most recurrent and most disabling symptoms of long COVID (LC) and is associated with a worse quality of life. Reducing body fat in these patients could be important to mitigate fatigue and post-exertional worsening. Aerobic exercise may not be indicated in LC patients who have orthostatic tachycardia and post-exertional worsening. The aim of this study was to evaluate the effects of a personalized supine therapeutic motor control exercise program on fatigue and fat tissue in women with LC.

METHODS
A single-arm exploratory case study, with a pre–post format, was conducted on 17 women with LC to test the effects of a plank-based strengthening exercise program on fatigue, which was evaluated by the Modified Fatigue Impact Scale and fat tissue assessed by bioimpedance. The twelve-week program included two weekly sessions. The exercise program was personalized, considering the symptoms and characteristics of the patients.

RESULTS
Participants with overweight or obesity (n = 12) comprised 70% of the entire sample. After completing the exercise program this value decreased by 5.9 percentage points. Significant differences were found in the total [(MD  = −1.72, 95% CI −2.57 to −0.86), r = 0.73], trunk, upper and inner limbs body fat percentages (p < 0.05). The overall fatigue decreased at 12 weeks [(MD  =  −14.00, 95% CI −21.69 to −6.31), r = 0.69] as well as the physical and psychosocial fatigue sub-scale (p  <  0.001); no differences were observed in the cognitive sub-scale.

CONCLUSIONS
The plank-based personalized strengthening exercise program showed rapid improvements in fatigue and fat percentages. It could be an effective strategy to achieve improvements for LC patients.

Link | PDF (Journal of Personalized Medicine) [Open Access]

 

[wabi-sabi]

This exercise program looks shockingly hard- 2 60 minute strength sessions twice a week! Anyone who can do this must be mild to begin with.
I wonder how much of the improvement in fatigue was due to weight loss, since they show fatigue to correlate with trunk fat and they go on quite a bit in the discussion section about the negative effects of excess body fat, so this seems to be their main argument. But.. then this article is about the benefits of body recomp, not a long COVID intervention per se. There weren't enough women in the study to try to see if the women who started t a normal BMI benefited to the same degree. I like that they note that the exercise program did not affect cognition. Hopefully this means it wasn't inducing PEM, but at least they don't claim that exercise is improving cognition. I do give them credit for avoiding aerobic exercise.

"With muscular fatigue and chronic fatigue, the muscle feels floppy and the force
generated by muscles is always low, causing the patient to feel frail constantly." This is an interesting sentence because I wonder who generalizable it is. My muscles mostly feel spastic and in pain due to that spasm. I don't feel frail-I feel like a have a full body charlie horse much of the time. Does anyone else have this?

 

[oldtimer]

Each session included 10 min of warm-up (3 min of specific exercise, sitting on the wall, 1 min of anterior plank on elbows and feet, 50 sit-ups, and 1 min of sustained sit-ups), 40 min of trunk musculature training, and 10 min of cool-down (breathing, stretching, and muscle relaxation). All sessions included abdominal exercises, gluteus maximus and gluteus medius, pelvic bridge (according to the Moreta Method) and planks: anterior plank on elbows or on hands with arms straight and side plank.

The participants progressed as follows: in the first sessions they performed 150 to 200 sit-ups and at the end of the study they achieved between 300 and 400 repetitions distributed throughout the class.

We incorporated more complex exercises each week, which included leg or arm exercises combined with abdominal exercise, with the aim of increasing tone and proprioception and learning the new sequence of contractions involved in stabilizing the trunk.

In the pelvic bridge, maintenance went from 5 min to 9 min, while alternating exercises with sets that evolved from 10 to 25 repetitions. In gluteus medius exercises they spent 2 min to 4 min of maintenance and while maintaining proper posture, they were able to increase the repetitions from 20 to 60 repetitions on each side. During plank exercises, they held the position for 15 to 30 s up to 60 s.

Little by little, more complex exercises were incorporated with weights that never exceeded 1 kg and with a fit ball to increase the complexity of the exercise, thus improving the tonal component, proprioception, and the involuntary maintenance of the muscles involved in the stabilization of the trunk.

Also, depending on the objective of the class, in addition to the toning of the trunk musculature and gluteus, they alternated with classes more aimed at hips and legs, where they went from 10 initial repetitions of quadriceps splits to 50 and others aimed at shoulder girdle, where they managed to evolve from 10 plank push-ups on knees and hands to 50 repetitions on feet and hands, being able to do so while maintaining all the body parameters requested for its correct execution (In these planks and push-ups, the correct contraction of the serratus muscle and latissimus dorsi is essential to prevent movement or detach the scapula from the trunk).

Really?!!

 

[wabi-sabi]

Really?!!

If you can do all this, are you even sick?

Did they mention a drop out rate? I didn't see one.

 

[wabi-sabi]

This is a terribly embarrassing admission, but even when I was fit and healthy I couldn't do 150 sit ups in one session. And I was proud of how long I spent in the gym!

I was watching some silly youtube videos about fitness (since I really miss the gym) and came across one where a young guy tries to do ww2 level fitness training. He finds it hard, despite looking pretty fit. That made me look up modern military fitness requirements, and as far as I can tell the US army currently requires fewer sit ups to pass basic training than this paper does for sick people. Sometimes I really think they just hate us..

 

[oldtimer]

If you can do all this, are you even sick?

Did they mention a drop out rate? I didn't see one.

I agree. I think even a healthy person of average fitness would find the programme a challenge. I know someone with LC with fatigue, who was quite fit beforehand but who can only work a few hours a week now. This person is unable to walk the dog around the local park anymore. They would laugh at this study.

300 to 400 sit-ups in a single session sounds unbelievable to me, even if they weren't all done at once. And 9 mins of pelvic bridge 'maintenance', whatever that means exactly, seems like an awful lot considering 12 of the 17 were overweight or obese. I'm curious what someone who is/has been extremely fit thinks about this.

I couldn't find a drop-out rate either.

Edit: Corrected number of overweight and obese.

 

[wabi-sabi]

And 9 mins of pelvic bridge 'maintenance', whatever that means exactly, seems like an awful lot considering 12 of the 17 were obese.

I am currently doing the Muldowney protocol which is an exercise program for EDS. I don't have EDS, but it's a really gentle exercise and something I can do a couple of days a week. It starts you with 1.5 minutes of exercises and builds up to 3 minutes of an exercise, like a bridge. That's enough to make me feel stronger, but I can overdo it even with 1.5 minutes. I don't see why 9 minutes of bridge would be necessary (unless your goal is to punish the lazy) if 3 minutes is enough to help the super bendy people.

Back when I was young and healthy in martial arts class I could do 40 sit ups in a session. I was never crazy fit, but I was proud of my abilities.

 

[Sean]

300 to 400 sit-ups in a single session sounds unbelievable to me,

It is so ridiculous it is obscene. Not at my fittest in my late teens could I have achieved anything close to that, and I was pretty fit.

The most generous possible interpretation here is that the researchers literally have no idea of what the average human can reasonably achieve, let alone sick people. And that is utterly appalling ignorance.

 

[Yan]

Same with me. In my teens I was doing combat sports on semi-international level. Was trained by a olympic gold medalist, and had in the same group another who later won gold. So we had somewhat intense training sessions. I don't remember well but I think that the number of sit-ups might have been around that 300-400 per session. About 50, rest a little, repeat, rest, repeat.. I too think that 300-400 is insane for someone who is overweight and is suffering from serious energy limiting illness. And sit-ups were not the only thing they were asked to do.

Twomey et al. [38] conducted a study involving 213 patients with LC; 71.4% of whom were experiencing chronic fatigue. The exacerbation of post-exertional symptoms affected most of the participants. No worsening of symptoms was reported in our trial.
The results are consistent with another study in which non-invasive brain stimulation paired with a rehabilitation program was effective in reducing fatigue in people with LC. The fatigue was also assessed by the MFIS [39].
The physiological mechanisms underlying the fatigue of LC patients are currently unknown, although evidence is emerging on a possible link with mental fog, a symptom also present in a large number of LC patients.

Got it. Clear the fog with exercise. \s

 

[Murph]

Each session included 10 min of warm-up (3 min of specific exercise, sitting on the wall, 1 min of anterior plank on elbows and feet, 50 sit-ups, and 1 min of sustained sit-ups), 40 min of trunk musculature training, and 10 min of cool-down (breathing, stretching, and muscle relaxation). All sessions included abdominal exercises, gluteus maximus and gluteus medius, pelvic bridge (according to the Moreta Method) and planks: anterior plank on elbows or on hands with arms straight and side plank.

The participants progressed as follows: in the first sessions they performed 150 to 200 sit-ups and at the end of the study they achieved between 300 and 400 repetitions distributed throughout the class.

We incorporated more complex exercises each week, which included leg or arm exercises combined with abdominal exercise, with the aim of increasing tone and proprioception and learning the new sequence of contractions involved in stabilizing the trunk.

In the pelvic bridge, maintenance went from 5 min to 9 min, while alternating exercises with sets that evolved from 10 to 25 repetitions. In gluteus medius exercises they spent 2 min to 4 min of maintenance and while maintaining proper posture, they were able to increase the repetitions from 20 to 60 repetitions on each side. During plank exercises, they held the position for 15 to 30 s up to 60 s.

Little by little, more complex exercises were incorporated with weights that never exceeded 1 kg and with a fit ball to increase the complexity of the exercise, thus improving the tonal component, proprioception, and the involuntary maintenance of the muscles involved in the stabilization of the trunk.

Also, depending on the objective of the class, in addition to the toning of the trunk musculature and gluteus, they alternated with classes more aimed at hips and legs, where they went from 10 initial repetitions of quadriceps splits to 50 and others aimed at shoulder girdle, where they managed to evolve from 10 plank push-ups on knees and hands to 50 repetitions on feet and hands, being able to do so while maintaining all the body parameters requested for its correct execution (In these planks and push-ups, the correct contraction of the serratus muscle and latissimus dorsi is essential to prevent movement or detach the scapula from the trunk).

Really?!!

I consider myself mild and I'm amazingly fit for a person with ME; I'm more open to exercise's benefits than most, especially recumbent exercise. But .... 50 sit-ups and a minute of plank is the warm up!?!?!

I just don't think you could find 12 overweight people who can do 200 situps in their first session, even among the healthy population.

Also they seem very confused about whether they were trying to reduce fat or build strength. Two strength sessions a week is not how you cut fat.

The whole thing is implausible.

 

[wabi-sabi]

The whole thing is implausible.

Yes, I was wondering about these weight loss results even for healthy people. I wouldn't expect this intervention to make for weight loss without dietary change, but I think they said the participants did not change their diet.

The other disappointing thing is how they reported the body fat change. There were only 12 women in this study, so they could have done a waterfall plot. Instead they give us means. Mean body fat dropped from 37% to 35%. They look at paired differences, but I think that's still means and not individuals. Stats experts correct me! Anyhow, some of the means of the paired differences are smaller than the standard deviations of the means, so this seems unimpressive, or at least a lot of interparticipant variability.

And when we look at the BMI numbers... oh dear. 8 women started out overweight... and 8 women ended overweight. 2 women started underweight and became normal weight, so that's good. 4 women started as class 1 obese and 3 women ended as class 1 obese. So 1 (just1!!!) woman in this study went from obese to normal BMI. But they try to hide this by giving percentages! All the women who started with a normal BMI ended with a normal BMI. The sum total of your weight loss intervention is that 1 woman lost weight and 2 gained (who needed to gain).... and then you go on about how much you helped due to excess body fat and inflammation. BLah, blah, blah.

But I'm jealous that these women can do 50 push ups.

 

[Eleanor]

I just don't think you could find 12 overweight people who can do 200 situps in their first session, even among the healthy population.

Also with a mean age of 45.

 

[Eleanor]

FWIW I've just asked a relative of mine who is a professional circus acrobat, her core muscles are steel. Answer: "we'd never do that many situps, they're not really optimal for abs".

 

[rvallee]

There's something really insane when a student who misunderstands the question, and thus answers it wrong, will fail, but academics who clearly misunderstand the problem and all its features can simply give themselves a solid pass, because they happen to be grading their own homework. Now let's just have someone equally confused about the problem grade that homework, which is similar to their own work and thus will be impacted by its grading. Really great system they got there.

The whole principle is literally insane: here's a bunch of people who experience serious worsening after exertion, let's exert them. Even homeopathy is less insane than this, and it's still completely wrong.

Except, by definition they can't experience PEM, since they are using high levels of exertion, apparently at the level of military bootcamps, which itself is absurd:

Our proposed program focused on fat reduction with no worsening of post-exertional symptoms.

It's exertion that does not cause worsening after exertion. Why didn't anyone think of that before?! Weakness is strength, my dear comrade Snowball.

Ignoring the absurd "reprogramming" thing, which sounds straight out of acupuncture:

The maintenance of maximum contraction, maintained for as long as possible, of the abdominals and stabilizing muscles, during the performance of all the exercises of the session, reprograms our nervous system, to increase muscle tone

Maximum contraction. So it's not just toning through contraction, it's maximum contraction, sustained for up to a minute. This is professional athlete level of fitness, as a baseline. How did no one notice how completely ridiculous this is?!

Given the heterogeneous characteristics of LC, the exercise program was completely personalized, considering the symptoms and characteristics of the patients at the beginning of the trial.

Everyone did the same exercises, which are fully personalized. Don't mind me, I'm going downstairs to get to the roof, wearing pants on my head, factory-made and customized for head comfort.

The program consisted of 2 60 min sessions per week on alternate days, with a total of 24 sessions.

The plank-based personalized strengthening exercise program showed rapid improvements in fatigue and fat percentages

"Rapid". "12 weeks". Words and their meaning, why bother?

I kind of repeat myself here, but this is an insane level of incompetence, and it only highlights how disturbing and deep the issues of basic validity in medical research go.

 

[Wonko]

I'm stuck on the idea that anyone could possibly do 400 sit ups and it be considered "Non-Aerobic".

As far as I know 400 reps of anything, or even 50, is aerobic exercise, even if the primary goal is to gain strength and not fitness.

Try doing 50 squats with 100kg and then tell me, when you can talk again, that it's not aerobic exercise.

Or even 20.

It's the number of reps that make it aerobic, not the activity per say.